Individual provider Active NPI

Amber Kozlov

  • Physical Therapist
  • Portland, OR
National Provider Identifier
1801101746
Registry record updated Sep 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
6275 Issued in OR
Practice address
2545 SW Terwilliger Blvd
Portland, OR 97201-5274
Phone
(503) 781-3087
NPI assigned
Aug 16, 2010
Last updated
Sep 11, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 6275 OR Primary

Addresses

Primary practice location

2545 SW Terwilliger Blvd
Portland, OR 97201-5274

Mailing address

2545 SW Terwilliger Blvd
Portland, OR 97201-6302
Phone (503) 808-7974

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130802000457 OR Practitioner - Physical Therapist in Private Practice 3779724729 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rehab Specialists Outpatient LLCGroup PAC ID 6507254497, 46 clinicians

Practice addresses (Care Compare)

1300 NE 16TH Ave
Portland, OR 97232-1467
Phone (503) 288-6671

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6275ORMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Rehab Specialists Outpatient, LLC Physical Therapist CurrentSince Feb 1, 2024 Accepting new patients
Rehab Specialists Outpatient, LLC Physical Therapist CurrentSince Feb 1, 2024 Accepting new patients

Locations

4560 SE International Way
Ste 100
Portland, OR 97222
Phone (971) 206-5129

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1281916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599782400000",
    "number": "1801101746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2545 SW TERWILLIGER BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972016302",
            "telephone_number": "503-808-7974",
            "fax_number": "503-820-5464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2545 SW TERWILLIGER BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972015274",
            "telephone_number": "503-781-3087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOZLOV",
        "first_name": "AMBER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-16",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "6275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.